Operationalizing Outpatient Bispecific Therapy: Practical Considerations for Safe and Sustainable Implementation
Published Date:
Practical Considerations for Safe & Sustainable Implementation
Authored by Tara Graff, DO, MS, and NCODA | October 2026
As bispecific therapies move into outpatient oncology settings, practices must prepare for care that extends beyond the infusion visit. Treatment initiation, toxicity monitoring, patient and caregiver education, and access to after-hours support all require coordinated planning.
This NCODA white paper draws on survey findings from 126 multidisciplinary oncology professionals, predominantly from community-based practices. It examines how teams are implementing outpatient bispecific T-cell engager (BTCE) therapy, the operational challenges they face, and practical considerations for establishing or expanding a program.
What the white paper explores:
- Program readiness and team responsibilities: Multidisciplinary leadership, staffing, and clearly defined roles.
- Treatment workflows: Product-specific protocols, step-up dosing schedules, order sets, and monitoring processes.
- Patient and caregiver preparation: Clinical eligibility, caregiver support, transportation, symptom recognition, and education before treatment begins.
- Safety and escalation pathways: Recognition and management of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), after-hours triage, and coordination with emergency and inpatient teams.
- Sustaining an outpatient program: Addressing operational barriers, refining workflows, and incorporating lessons learned through ongoing quality improvement.
The findings highlight the systems needed to support safe outpatient care: prepared patients and caregivers, consistent workflows, and a care team ready to respond across settings.
This project was sponsored by AbbVie. NCODA and the physician author retained full editorial independence and final editorial control over the content, interpretation of findings, and conclusions.